肾滤过分数评价肾动脉支架植入术对动脉硬化性肾动脉狭窄的治疗效果  

Significance of renal filtration fraction evaluation of renal artery stenting for atherosclerotic renal artery stenosis treatment

作　　者：冯琦琛[1] 李选[1] 栾景源[1] 王昌明[1] 李天润[1] 

机构地区：[1]北京大学第三医院介入血管外科,北京100191

出　　处：《北京大学学报（医学版）》2017年第1期158-163,共6页Journal of Peking University:Health Sciences

摘　　要：目的:探讨肾滤过分数(filtration fraction,FF)评价肾动脉支架植入术对动脉硬化性肾动脉狭窄治疗效果的意义。方法:对42例肾动脉狭窄患者,共52条肾动脉行肾动脉支架植入术(percutaneous transluminal renal angioplasty and stent,PTRAS),分析患者健侧肾和患侧肾(分肾)肾小球滤过率(glomerular filtration rate,GFR)、分肾肾有效血浆流量(effective renal plasma flow,ERPF)和分肾肾滤过分数的变化,术前与术后血肌酐(serum creatinine,s Cr)变化,观察患者血压(收缩压)和服用降压药种类的变化。结果:52例肾动脉支架植入手术全部成功,术前患侧GFR明显低于健侧(t=-3.989,P=0.000),ERPF明显低于健侧(t=-4.926,P=0.000)。两侧总体FF值相当(t=1.273,P=0.207),术后患侧肾GFR有所增高,但差异无统计学意义(t=-1.411,P=0.164),术后患侧肾ERPF明显增高(t=-4.954,P=0.000)、FF降低(更趋近于正常值,t=3.274,P=0.002)。术后健侧GFR明显降低(t=2.569,P=0.000),ERPF明显降低(t=3.889,P=0.001),FF无明显变化(t=-0.758,P=0.454)。术后患侧GFR低于健侧(t=-3.283,P=0.002),ERPF低于健侧(t=-3.351,P=0.001),但两侧FF值相当(t=-0.361,P=0.719)。术前FF相对正常的患肾,术后FF值变化较小(t=0.799,P=0.430);术前FF明显升高的患肾,术后FF值较术前降低(趋向正常值,t=5.299,P=0.000)。患者术后总体血肌酐较前明显下降(t=2.505,P=0.016),但对于单侧肾动脉狭窄患者,其血肌酐变化差异无统计学意义(t=1.228,P=0.299);而对于双侧肾动脉狭窄患者,血肌酐较术前明显下降(t=2.518,P=0.030),患者术后血压(收缩压)较术前明显下降(t=8.945,P=0.000),服用降压药物种类较术前明显减少(t=5.280,P=0.000)。结论:对于肾动脉狭窄患者,分肾FF是了解肾缺血病理生理进程的有益指标,术前FF显著增高或FF相对正常,应视为肾动脉支架植入术的手术指征。Objective： To investigate the significance of filtration fraction（ FF） and renal artery stenting in the treatment of atherosclerotic renal artery stenosis. Methods： In the study,42 cases of renal artery stenosis were treated with 52 renal artery stent implantation. Percutaneous transluminal renal angioplasty and stent（ PTRAS） of the patients＇ health side kidney,ipsilateral kidney（ renal） glomerular filtration rate（ GFR）,renal effective renal plasma flow effective renal plasma flow（ ERPF）,kidney filtration fraction changes of preoperative and postoperative serum creatinine（ SCR） and the changes in the patients with blood pressure（ SBP） and the changes after taking antihypertensive drugs were observed and analyzed. Results： The 52 cases of renal artery stent implantation were all successful. Preoperative ipsilateral GFR was significantly lower than that of normal side（ t =-3. 989,P = 0. 000）; preoperative ipsilateral ERPF was significantly lower than the contralateral side（ t =-4. 926,P = 0. 000）. On both sides,the overall FF values were equal（ t = 1. 273,P = 0. 207）. Postoperative ipsilateral renal GFR was increased,but there was no statistical difference（ t =-1. 411,P = 0. 164）. Postoperative ipsilateral renal ERPF was increased significantly（ t =-4. 954,P = 0. 000）,and FF lower（ closer to the normal value（ t = 3. 274,P = 0. 002）. Postoperative side GFR was significantly reduced（ t = 2. 569,P =0. 000）,the contralateral ERPF was significantly reduced（ t = 3. 889,P = 0. 001）,and FF had no significant change（ t =-0. 758,P = 0. 454）. Postoperative side GFR was lower than that of the contralateral（ t =-3. 283,P = 0. 002） and postoperative side ERPF was still lower than that of the contralateral（ t =-3. 351,P = 0. 001）,but on both sides,the FF values were equal（ t =-0. 361,P = 0. 719）.Preoperative FF was relatively normal in the patients with kidney,and the postoperative FF value change was small（ t = 0. 799,P = 0. 430）; preoperat

关 键 词：肾动脉梗阻 支架 肾小球率过滤 肾血流量 有效 肾滤过分数 

分 类 号：R541.3[医药卫生—心血管疾病]